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Pneumologie 2017; 71(06): 325-397
DOI: 10.1055/s-0043-105954
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

S2k-Leitlinie: Tuberkulose im Erwachsenenalter

Eine Leitlinie zur Diagnostik und Therapie, einschließlich Chemoprävention und -prophylaxe des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose e.V. im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V.Tuberculosis Guideline for AdultsGuideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)
Tom Schaberg (federführend)
 1   Agaplesion Diakonieklinikum Rotenburg, Zentrum für Pneumologie, Rotenburg (Wümme)
,
Torsten Bauer
 2   Lungenklinik Heckeshorn, Klinik für Pneumologie im HELIOS Klinikum Emil von Behring, Berlin
 3   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK e.V.), Berlin
,
Folke Brinkmann
 4   Universitäts-Kinderklinik, Bochum
,
Roland Diel
 5   Institut für Epidemiologie Universitätsklinikum Schleswig-Holstein, Campus Kiel c/o LungenClinic, Grosshansdorf
 6   Deutsches Zentrum für Lungenforschung (DZL)
,
Cornelia Feiterna-Sperling
 7   Charité – Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin
,
Walter Haas
 8   Abteilung für Infektionsepidemiologie, Fachgebiet für respiratorisch übertragbare Erkrankungen des Robert Koch-Instituts (RKI), Berlin
,
Pia Hartmann
 9   Institut für Medizinische Mikrobiologie, Immunologie und Hygiene (IMMIH), Uniklinik Köln
10   Labor Dr. Wisplinghoff, Köln
,
Barbara Hauer
 8   Abteilung für Infektionsepidemiologie, Fachgebiet für respiratorisch übertragbare Erkrankungen des Robert Koch-Instituts (RKI), Berlin
,
Jan Heyckendorf
11   Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel
12   Deutsches Zentrum für Infektionsforschung (DZIF), Klinische Tuberkuloseeinheit (ClinTB), Borstel
13   International Health/Infectious Diseases, Universität zu Lübeck
,
Christoph Lange
11   Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel
12   Deutsches Zentrum für Infektionsforschung (DZIF), Klinische Tuberkuloseeinheit (ClinTB), Borstel
13   International Health/Infectious Diseases, Universität zu Lübeck
14   Department of Medicine, Karolinska Institute, Stockholm, Schweden
,
Albert Nienhaus
15   Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
Ralf Otto-Knapp
 3   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK e.V.), Berlin
16   MVZ PneumoCare, Berlin
,
Martin Priwitzer
17   Landeshauptstadt Stuttgart, Gesundheitsamt
,
Elvira Richter
18   MVZ Labor Dr. Limbach, Heidelberg
,
Rudolf Rumetshofer
19   2. Lungeninterne Abteilung, Otto Wagner Spital, Wien, Österreich
,
Karl Schenkel
 3   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK e.V.), Berlin
,
Otto Dagobert Schoch
20   Departement Innere Medizin, Klinik für Pneumologie, Kantonsspital St. Gallen, Schweiz
,
Nicolas Schönfeld
 2   Lungenklinik Heckeshorn, Klinik für Pneumologie im HELIOS Klinikum Emil von Behring, Berlin
 3   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK e.V.), Berlin
,
Ralf Stahlmann
21   Charité – Universitätsmedizin Berlin, Institut für Klinische Pharmakologie und Toxikologie, Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
26. Juni 2017 (online)

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Zusammenfassung

In Deutschland ist seit 2015 ein deutlicher Anstieg der gemeldeten Tuberkulosefälle zu verzeichnen. Zurückzuführen ist dieser vor allem auf die aktuell vermehrte Migration. Durch die niedrige Inzidenz in den vorhergehenden Jahren konzentriert sich die Erfahrung im Umgang mit Tuberkulose immer mehr auf spezialisierte Zentren. Pneumologen wie auch andere Fachbereiche sind nun aber wieder häufiger an der Behandlung einer Tuberkulose beteiligt, sodass Fachwissen zur Standardtherapie wie auch zu selteneren Therapiesituationen benötigt wird. Die aktuelle Leitlinie zur Diagnostik und Therapie, einschließlich Chemoprävention und -prophylaxe im Erwachsenenalter fasst den derzeitigen Wissensstand zusammen und passt die Empfehlungen an die Situation in Deutschland an. Realisiert wurde die AWMF S2k-Leitlinie durch das Deutsche Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK) im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP). Zur Behandlung der Tuberkulose im pädiatrischen Bereich wird in Kürze eine eigenständige Leitlinie der entsprechenden Fachgesellschaften veröffentlicht. Im Vergleich zu den Empfehlungen von 2012 sind eigenständige Kapitel zur Labordiagnostik und zum therapeutischen Medikamentenmanagement entstanden. Die Kapitel Mehrfachresistenzen gegen Medikamente der Standardtherapie, HIV-Koinfektion und die Übersicht der Arzneimittel wurden erweitert. Die umfangreiche Überarbeitung der Empfehlungen soll Ärzten und auch anderen Beschäftigten im Gesundheitswesen helfen, den aktuellen Herausforderungen im Umgang mit dem selten gewordenen Tuberkuloseerreger zu begegnen.

Abstract

Since 2015 a significant increase in tuberculosis cases is notified in Germany, mostly due to rising numbers of migrants connected to the recent refugee crisis. Because of the low incidence in previous years, knowledge on tuberculosis is more and more limited to specialized centers. However, lung specialist and healthcare workers of other fields have contact to an increasing number of tuberculosis patients. In this situation, guidance for the management of standard therapy and especially for uncommon situations will be essential.

This new guideline on tuberculosis in adults gives recommendations on diagnosis, treatment, prevention and prophylaxis. It provides a comprehensive overview over the current knowledge, adapted to the specific situation in Germany. The German Central Committee against Tuberculosis (DZK e. V.) realized this guideline on behalf of the German Respiratory Society (DGP). A specific guideline for tuberculosis in the pediatrics field will be published separately. Compared to the former recommendations of the year 2012, microbiological diagnostics and therapeutic drug management were given own sections. Chapters about the treatment of drug-resistant tuberculosis, tuberculosis in people living with HIV and pharmacological management were extended. This revised guideline aims to be a useful tool for practitioners and other health care providers to deal with the recent challenges of tuberculosis treatment in Germany.

 

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